Program Goals While recent interventions have shortened hospitalizations for U.S. newborns with neonatal opioid withdrawal syndrome (NOWS), few resources have been directed towards implementing and studying models for these children’s long-term pediatric care. At a large urban medical center with existing adult addiction services, the Supporting Our Families through Addiction and Recovery (SOFAR) program was launched in July 2017. Through a trauma-informed, developmentally focused, family-centered pediatric model for parent-child dyads in opioid-impacted families, the SOFAR program promotes healthy child development and parental relapse prevention. We aim to determine whether the program improves attendance at well-child visits, decreases emergency department use, strengthens parent-child attachment, and supports parents’ recovery compared to families without specialized supports. Evaluation The SOFAR program includes: (1) co-location and coordination of primary care and other services for infants and parents; (2) a trauma-sensitive, non-stigmatizing environment; (3) strong continuity and frequent contacts with multidisciplinary team members; and (4) case management with links to social, community, and parenting resources. Through a comprehensive mixed methods evaluation, process and outcome metrics are being gathered. Evaluation data include patient interviews, retrospective electronic medical record (EMR) data, and a prospective database of SOFAR (and control) families. During its first 18 months, the SOFAR program served 141 children, 114 of whom remain in the program. During this time, we became aware of 17 maternal relapses, one maternal overdose death, and 8 paternal overdose deaths. Sixty-nine mother-child dyads received care during infancy in the program’s first twelve months. 74% of mothers were hepatitis C-infected. Housing insecurity was common; 35% lived in residential recovery programs. At delivery, 95.5% of mothers were using medication-assisted treatment (MAT): 54.0% used methadone, 44.4% used buprenorphine, and 1.6% used naltrexone. About 50% of mothers had older children. Maternal anxiety, depression, and trauma histories were common. Emerging themes include: maternal guilt and shame, family vulnerability, feeding difficulties and formula changes, and logistical obstacles to keeping appointments. Coordination between children’s multiple services and with parents’ services was a significant challenge and a key point of program intervention. Discussion SOFAR is a promising model for families facing opioid use disorder, providing parents and children with consistent multidisciplinary care. A team approach is central to the program. Clinicians, nurses, social workers, patient navigators, and community agencies must collectively hold responsibility for supporting families, using systems that facilitate communication across departments and with agencies. Future needs include (1) expanding access to non-stigmatizing, trauma-informed developmentally-focused care for parent-child dyads, (2) centering family needs, including mechanisms to address logistical barriers and social determinants of health, and (3) preventing future substance use disorder in impacted children. As pediatric clinicians, we are optimistic that these interventions will benefit families, and that our advocacy can improve awareness of this population’s needs.
Characteristics of Infants in the SOFAR Clinic during Year 1, July 11, 2017 – July 11, 2018